A retrospective cohort study of liver toxicity in hepatitis B and C HIV co-infected patients in the HIV Ontario Observational Database

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Тромботическая тромбоцитопеническая пурпура - редкая этиопатогенетическая причина инфаркта головного мозга и экстрацеребрального тромбоза

Thrombotic thrombocytopenic purpura is a disease from the group of thrombotic microangiopathies, the early diagnosis of which is a real challenge in clinical practice. The article presents a clinical case that clearly illustrates the multisystem nature of the damage against the background of thrombotic microangiopathy, specific parameters of diagnosis, and emergency therapy Timely initiation of specific treatment significantly increases the chances of survival in this category of patients.Тромботическая тромбоцитопеническая пурпура - это заболевание из группы тромботических микроангиопатий, ранняя диагностика которого является трудной задачей в клинической практике. В статье представлен клинический случай, наглядно иллюстрирующий мультисистемность поражения на фоне тромботической микроангиопатии, особенности диагностики и неотложной терапии. Своевременное начало специфического лечения на порядок увеличивает шансы на выживание

НЕЙРОПЕПТИД S100-b: ДИАГНОСТИКА ЗЛОКАЧЕСТВЕННОГО ТЕЧЕНИЯ ИНФАРКТА МОЗГА

The major heart attack in the carotid system, going with the cerebral edema is considered to date as the most mortal type of the ischemic stroke. The only prove successful treatment policy is the decompressive craniectomy. The early start of the operative intervention, reported in the references, brings about improvement of the clinical outcomes, however under limited time the diagnostics issues remain open and, as a consequence there perform the unreasonable traumatic operational assistance. 43 patients with the severe ischemic stroke were examined and an analysis of the S100-b glial peptide as a marker of malignant brain infarction course was performed. The neuropeptide monitoring in the blood serum allows detection of the responders to the decompressive craniectomy among the high-risk patients within 12-16 hours of the disease onset till the clinical deterioration development, when according to the computerized tomography the certain changes have not in yet. Наиболее фатальным типом ишемического инсульта на сегодняшний день считается обширный инфаркт в каротидном бассейне, сопровождаемый отёком мозга. Единственная доказавшая эффективность лечебная тактика - декомпрессионная краниоэктомия. Раннее начало оперативного вмешательства приводит, по данным литературы, к улучшению клинических исходов, но в условиях сжатых сроков остаются открытыми вопросы диагностики и, как следствие, проведения необоснованных травматичных оперативных пособий. Провели обследование 43 пациентов с клиникой тяжёлого ишемического инсульта и оценку значимости глиального пептида S100-b как маркёра злокачественного течения инфаркта головного мозга. Мониторинг нейропептида в сыворотке крови позволяет выявлять респондеров для декомпрессионной краниоэктомии среди пациентов группы риска в пределах 12-16 ч от начала заболевания до развития клинического ухудшения, когда соответствующие изменения, по данным компьютерной томографии, ещё не наступили

КОМБИНИРОВАННАЯ ИНТЕРВЕНЦИОННАЯ ТЕРАПИЯ ИНФАРКТА ГОЛОВНОГО МОЗГА В БАССЕЙНЕ СРЕДНЕЙ МОЗГОВОЙ АРТЕРИИ

Ishemic stroke is a frequent cause of disability and mortality. Standard therapy of patients admitted within 4.5 hours from the start of symptoms is systemic thrombolysis if there are no contraindications to it. And intervening therapy is a new treatment technique in case of occlusion of the major brain arteries. The clinical case is described: 71 year old patient with brain infarction in the middle cerebral artery circulation was admitted to hospital in time, but he had contraindications to systemic thrombolytic therapy, and he was treated with intervening therapy demonstrating good restoration of the functions. Ишемический инсульт – частая причина инвалидизации и смертности. Стандартной терапией для пациентов, поступивших в течение 4,5 ч от начала симптомов и при отсутствии противопоказаний, является системный тромболизис. В отличие от этого, интервенционная терапия является новым вариантом лечения при окклюзии магистральных артерий головного мозга. Приведено описание клинического случая: 71-летний пациент с инфарктом головного мозга в бассейне правой средней мозговой артерии поступил в срок, но имел противопоказания для системной тромболитической терапии, ему выполнено комбинированное интервенционное лечение с хорошим функциональным восстановлением.

Диссекция как причина тромбоза внутренней сонной артерии и мишень для интервенционного лечения инфаркта головного мозга

Acute ischemic stroke is a common cause of disability and mortality. In some rare cases, it can result from the structural changes in the major extracranial arteries, including vascular dissection. Due to the low incidence, the management of the acute period of dissection-associated stroke is not completely understood.In the clinical case presented, we describe the medical history of a forty years old patient in the acute period of cerebral infarction related to the dissection of the internal carotid artery, including the techniques and possible results of endovascular therapy. In this clinical scenario of acute stroke period, emergency angioplasty and stenting of carotid artery have been shown to be a highly effective approach.Ишемический инсульт – частая причина инвалидизации и смертности. В ряде случаев его причиной может быть патология магистральных экстракраниальных артерий, в том числе их диссекция. В связи с низкой частотой встречаемости тактика ведения острейшего периода инсульта, обусловленного диссекцией, окончательно не определена.В данном клиническом случае на примере 40-летней пациентки дано описание приемов и возможностей эндоваскулярной терапии в острейшем периоде инфаркта головного мозга на фоне диссекции внутренней сонной артерии. Использование неотложной ангиопластики и стентирования сонных артерий в острейшем периоде инсульта может быть эффективно при лечении пациентов с данной патологией артерий шеи

The Role of the Transitional Leader : A Comparative Analysis of Adolfo Suárez and Boris Yeltsin

The role of leadership in transitional regimes is an issue that requires closer examination, given the ability of the leader to shape and determine the direction of the regime. This paper seeks to delineate some common features of leadership during such regimes and the factors influencing the ability of leaders to manipulate and shift the direction of the process. To illustrate, it adopts a comparative analysis of the leadership of Adolfo Suárez (Spain) and Boris Yeltsin (Russia). It will be shown that, despite the different outcomes of these cases, there are clear similarities that point to the existence of a form of transitional leadership. Central to the paper is an adoption of the notion of structure and agency to determine the extent actors in this position can affect change within the constraints faced

The prevalence of hyperlipidemia in patients co-infected with hepatitis C and human immunodeficiency virus

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A retrospective cohort study of liver toxicity in hepatitis B and C HIV co-infected patients in the HIV Ontario observational database (HOOD)

Objectives: To identify risk factors for significant hepatic dysfunction among HIV-hepatitis B (hepB) or hepatitis C (hepC) co-infected patients related to antiretroviral (ART) exposure. Methods: All HOOD patients that were chronic carriers of hepB or hepC were identified. ART medication and laboratory adverse event data were obtained through bi-annual chart reviews. Results: 404 HIV co-infected patients were identified (hepC(n=317); hepB(n=104); both hepC/hepB(n=17). 243 (60%) and 249 (62%) of these patients had ever had grade 3 or 4 elevations in ALT and AST respectively versus 676 (41%) and 673 (41%) (p<.001 and p<.001) of those with HIV not co-infected. The median (IQR) duration of infection with hepC and/or hepB at the time of initial identification of elevations in transaminases(AST/ALT) was 842 days (260,1780). The median (IQR) time after starting any ART to the development of Grade 3 or 4 hepatic dysfunction was 896 days (216,1680). Grade 3 or 4 elevations in AST/ALT were significantly associated with ever taking: a boosted PI (72% vs 59%, p=.01), ritonavir (70% vs 51%, p=.0001), ddI (66% vs 56%, p=.03) and a trend with ever taking d4T (63% vs 54%, p=.06) but not with taking a nelfinavir based regimen without previous exposure to ritonavir, d4T and/or ddI(61% vs 62%, p=.96). Patients who had ever had grade 3 or 4 elevations in ALT/AST also had exposure to higher median numbers of all types of ARTs (6 vs 5, p<.001), nucleoside reverse transcriptase inhibitors (4 vs 3, p=.001), nonnucleoside reverse transcriptase inhibitors (1 vs 0, p=.004) and PIs (2 vs 1, p=.002). Conclusions: A high proportion of HIV patients co-infected with hepB and hepC have serious elevations in transaminases which may be related to both type and cumulative exposure to ART. Patients exposed to boosted PI regimens, ddI and d4T appear to be at heightened risk and patients on nelfinavir-based regimens without previous exposure to other PIs or ddI/d4T at lower risk for serious hepatotoxicity

NEUROPEPTIDE S100-b: THE DIAGNOSIS OF A MALIGNANT CEREBROVASCULAR ACCIDENT

The major heart attack in the carotid system, going with the cerebral edema is considered to date as the most mortal type of the ischemic stroke. The only prove successful treatment policy is the decompressive craniectomy. The early start of the operative intervention, reported in the references, brings about improvement of the clinical outcomes, however under limited time the diagnostics issues remain open and, as a consequence there perform the unreasonable traumatic operational assistance. 43 patients with the severe ischemic stroke were examined and an analysis of the S100-b glial peptide as a marker of malignant brain infarction course was performed. The neuropeptide monitoring in the blood serum allows detection of the responders to the decompressive craniectomy among the high-risk patients within 12-16 hours of the disease onset till the clinical deterioration development, when according to the computerized tomography the certain changes have not in yet

COMBINED INTERVENING THERAPY OF BRAIN INFARCTION IN THE MIDDLE CEREBRAL ARTERY CIRCULATION

Ishemic stroke is a frequent cause of disability and mortality. Standard therapy of patients admitted within 4.5 hours from the start of symptoms is systemic thrombolysis if there are no contraindications to it. And intervening therapy is a new treatment technique in case of occlusion of the major brain arteries. The clinical case is described: 71 year old patient with brain infarction in the middle cerebral artery circulation was admitted to hospital in time, but he had contraindications to systemic thrombolytic therapy, and he was treated with intervening therapy demonstrating good restoration of the functions